Laserfiche WebLink
ryA t=�YY <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 r <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. r, <br /> ...al.z........Git(:r ............ ................... ......0 r�....i:.�1a. . f� .................................... I <br /> OWN E R (please prit) _, <� C' CONT ACTOR br S; AVE7�PR or AGENT a ��}--. <br /> i �qVl _ 'ly},� <br /> ... 7 .G.......... ...................:.............�.......... ....7........ .ADDR..S . .. .......... ............................................................ d :�+ <br /> AD EVO <br /> SS / <br /> Q.. ... �... ......... <br /> ADDRFS51 .. ... ., . .... ..... .....DRF .. {-�t.....Vy!,.k....:,.J.� :�..................... <br /> ADDRESS <br /> ........................................................................................... ............................................................................................ <br /> PHON.E. ............................................................................... PHONE <br /> PLUMBER WELL DRI LLE..R................................................................... i i iLY <br /> ........................................................................................... ............................................................................................ <br /> O <br /> ADDRESS ADDRESS <br /> o <br /> . ...................................................................... ... ..................................................................................... <br /> PHONE PHON.... E <br /> Zr <br /> DESCRIPTION 4. Sanitary Facilities: R o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building No. Bedrooms .......... i <br /> .......... Type of Construction: <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... i <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> �i <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type ............................. ...... <br /> .......... ........................... ............... <br /> 0 <br /> 17 <br /> Mobile Home .......... $IOPe .......................................... �+ <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Pere, Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> Camping Unit .....I.... Privy .......... <br /> .................................................... Seepage Bed <br /> ---------------------------------------------------------------.--__---- (] N <br /> Location of proposed structures and existing structures, well, sewage systems,.roads, etc., should be sketched in Fig. A. Include road �i <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway inter- a <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> O <br /> -----------------.---- --_—_------_---- - f <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. Q i E <br /> I Il'v � <br /> ��J m <br /> c <br /> Isla-l� � <br /> , f o <br /> , I <br /> t . i <br /> �.' . . an r 1) to m Z <br /> n fA Cp < c m <br /> n - F <br /> m on o a n m <br /> P' <. 0 `-. m <br /> Z op_' . D <br /> O 69 a m <br /> ? m <br /> 7J <br /> m <br /> .............Ow' '.e'r'...A'g'e"l..... <br /> ......................... <br /> ................ a"t' ................ � _p <br /> Signature of Owner or Agent Date <br /> X{{ 31 <br /> Remarks ......................................................................................................................................................................... m <br /> m <br /> ........................................................................................................... / .... . . . . . . <br /> -/�J' . <br /> Inspection Date ....................................... �7r �... ! , /.. .......... y� a o N o m <br /> Zoning Administra o 8 8 8 8 8 8 tmn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any bLldd- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the Information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not lie more without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />